For over two years, the AARC has worked diligently with other national pulmonary medical societies and patient groups to address problems with access to home mechanical ventilation. Technologies have changed over the past decade and the Centers for Medicare and Medicaid Services (CMS) has not kept pace, resulting in inappropriate billing, increased utilization, and a large spike in expenditures. Further, a report by the Inspector General in September 2016 titled “Escalating Medicare Billing for Ventilators Raises Concerns” substantiated the issues we raised with CMS.
Meetings with the agency’s Coverage and Analysis Group, a 45-page white paper on the need for change submitted to the local Medicare Administrative Contractors who, according to Central Office, had discretion to revise local policies, and a formal request to CMS to reconsider its National Coverage Determination (NCD) resulted in “no action.”
Now, with new leaders in Congress, we have Congressional support from Representative Chris Collins from New York’s 27th District. As a member of the House Energy and Commerce Committee, he has written a letter to Health and Human Services Secretary Tom Price appealing to his background as a medical professional to get CMS to resolve the problems and act on our formal NCD Reconsideration request.
It’s too soon to tell the impact of the request since it was just sent on April 25, 2017, but it’s a huge step in the right direction. If all else fails, a legislative amendment would be the next logical step, but it is always best to try and resolve things before it is elevated to that level. We will keep our members up-to-date as matters unfold.